Protocolo EMPODERACO para mudança de comportamento de pacientes em anticoagulação oral com varfarina

Abstract

Warfarin is an oral anticoagulant widely used by cardiac patients with atrial fibrillation. This drug exhibits a narrow therapeutic index and wide variability in dose-response, and the control of oral anticoagulation with warfarin represents a major challenge in the patient care process. Previous studies have evidenced positive contributions of strategies that favored behavior change in patients with chronic diseases. In this sense, patients under oral anticoagulation with warfarin could benefit from behavioral strategies aimed at improving their active participation in self-care and adherence to drug therapy. The aim of the present study was to build and validate the EmpoderACO protocol for behavioral change in the use of oral anticoagulation with warfarin. The development of the instrument was preceded by literature review, analysis of concepts and construction of theoretical definitions and a conceptual map. The relevance, adequacy and clarity of each item of the instrument were evaluated through a committee of judges composed of a multiprofessional team through an online platform. The pre-test was performed in the field with 30 warfarin patients attended at the anticoagulation clinic of the Hospital das Clínicas of the Universidade Federal de Minas Gerais, which evaluated the understanding of the protocol items. During the construction of the instrument 10 versions were preceded until the final version that was named EmpoderACO. The committee of judges was composed of 34 professionals including: physicians, nurses, pharmacists, nutritionists, pedagogue and linguists. The internal reliability was calculated by the content validity coefficient (CVC) of the evaluation made by the judges committee and it was obtained satisfactory of compliance superior to 0.91 of the items. The measurement of the instrument measured from a selected pension with a mean CVC equals 0.96. It is understood that this protocol can contribute to the elaboration of strategies that qualify the communication process between professionals and patients, increase the patients' understanding of their health problem and oral anticoagulant therapy, as well as promote effective communication and decision making. In addition, there are perspectives of improving adherence to treatment with warfarin, clinical outcomes and minimizing the risks arising from this drug therapy, so that it may be replicated in other anticoagulation clinics with a similar profile.